Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $85.11 / $125.89	Facility	26	$67.61	$85.11	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $338.84 / $1,258.93	Professional		$114.82	$338.84	$1,258.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $120.23 / $302.00	Professional	26	$63.10	$120.23	$302.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $288.40 / $660.69 / $2,041.74	Professional	50	$288.40	$660.69	$2,041.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $107.15 / $288.40 / $524.81	Professional	52	$107.15	$288.40	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $269.15 / $741.31	Professional	TC	$141.25	$269.15	$741.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $173.78 / $331.13	Professional		$147.91	$173.78	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $60.26 / $112.20	Professional	26	$47.86	$60.26	$112.20
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $602.56 / $602.56 / $602.56	Professional	50	$602.56	$602.56	$602.56
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $165.96 / $389.05	Professional	TC	$102.33	$165.96	$389.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $398.11 / $676.08	Professional		$251.19	$398.11	$676.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $87.10 / $141.25	Professional	26	$67.61	$87.10	$141.25
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $380.19 / $588.84 / $1,023.29	Professional	50	$380.19	$588.84	$1,023.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $309.03 / $524.81	Professional	TC	$177.83	$309.03	$524.81
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $251.19 / $389.05	Professional		$218.78	$251.19	$389.05
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $79.43 / $125.89	Professional	26	$70.79	$79.43	$125.89
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $169.82 / $263.03	Professional	TC	$147.91	$169.82	$263.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $158.49 / $288.40	Professional		$66.07	$158.49	$288.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $104.71	Facility	26	$15.49	$72.44	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $380.19 / $741.31	Professional		$199.53	$380.19	$741.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $87.10 / $151.36	Professional	26	$56.23	$87.10	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $239.88 / $616.60	Professional	TC	$134.90	$239.88	$616.60
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $104.71	Facility	26	$15.49	$72.44	$104.71
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $346.74 / $707.95	Professional		$177.83	$346.74	$707.95
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $93.33 / $186.21	Professional	26	$56.23	$93.33	$186.21
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $245.47 / $645.65	Professional	TC	$131.83	$245.47	$645.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $147.91	Professional		$32.36	$33.11	$147.91
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	26	$295.12	$295.12	$295.12
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $234.42 / $371.54	Professional		$128.82	$234.42	$371.54
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $81.28 / $138.04	Professional	26	$61.66	$81.28	$138.04
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $144.54 / $263.03	Professional	TC	$67.61	$144.54	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $281.84 / $575.44	Professional		$190.55	$281.84	$575.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $70.79 / $131.83	Professional	26	$53.70	$70.79	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $186.21 / $467.74	Professional	TC	$131.83	$186.21	$467.74